A SUCCESSFUL COVERAGE USING INTERCOSTAL MUSCLE WITH VASCULAR PEDICLE FOR ANASTOMOTIC LEAKAGE OF INTRATHORACIC ESOPHAGOJEJUNOSTOMY AFTER A TOTAL GASTRECTOMY -REPORT OF A CASE-

We successfully conducted reanastomosis and coverage using intercostal muscle with vascular pedicle for a wide raning anastomotic leakage of intrathoracic esophagojejunostomy after a total gastrectomy. As the intrathoracic pressure is negative, the treatment for a wide-ranging anastomotic leakage at the region focuses on the complete prevention of leakage of contents in the intestine. for that, we have to simultaneously close the anastomotic breakdown, remove the intestinal content, and convert the intrathoracic pressure to positive. In this case, we have conducted the reanastomosis and reinfocement of the leaked site applying coverage method by intercostal muscle with vascular pedicle which has been employed for esophageal injuries. In order to remove the content of the intrathoracic intestine, aspiration from the oral cavity was repeatedly performed to reduce the pathing volume of saliva, and a fistula tube was inserted through a stump of the duodenum to prevent regurgitaiton of alimentary juice. The reanastomosed site in the thoracic cavity was appropriately oppressed by continuous positive breathing that lessened dead spaces and the leakage was successfully cured. The postoperative course was uneventful, and no stenosis has been noted thereafter. We think that this procedure is also useful for anastomotic leakage.